What is the recommended tapering schedule for discontinuing Zoloft (sertraline)?

Sertraline (Zoloft) Tapering Schedule

The recommended tapering schedule for discontinuing Zoloft (sertraline) is a gradual reduction of 10% of the original dose each week, maintaining the same dosing frequency, with slower tapering for patients experiencing withdrawal symptoms. 1

General Tapering Principles

• A gradual taper is strongly recommended to minimize withdrawal symptoms and maximize successful discontinuation
• Slower tapers are better tolerated than rapid tapers, particularly for long-term users
• Tapering too rapidly increases withdrawal symptoms and reduces success rates

Standard Tapering Schedule

1. Initial Phase: Reduce dose by 10% of original dose each week

   • Example: 100mg → 90mg → 80mg → 70mg, etc.
   • Maintain same dosing frequency throughout taper

2. Final Phase: When reaching lowest available dose unit (typically 25mg for sertraline):

   • Increase time intervals between doses
   • Example: 25mg daily → 25mg every other day → 25mg every third day → discontinue

Extended Tapering for Difficult Cases

For patients experiencing significant withdrawal symptoms, consider a hyperbolic taper:

• Reduce by 25% of the most recent dose every 2-4 weeks 2
• Example: 100mg → 75mg → 56mg → 42mg → 32mg → 24mg → 18mg → etc.
• This approach reduces serotonin transporter inhibition in a more linear manner

Monitoring During Tapering

• Weekly follow-up during active tapering is recommended
• Assess for withdrawal symptoms at each visit
• Adjust tapering schedule based on individual tolerance

Managing Withdrawal Symptoms

Common withdrawal symptoms include:

• Somatic: Dizziness, light-headedness, nausea, fatigue, flu-like symptoms, sensory disturbances, sleep problems
• Psychological: Anxiety, agitation, crying spells, irritability

If withdrawal symptoms occur:

1. Reassure patient that symptoms are usually transient
2. For severe symptoms, return to previous dose and slow the taper rate
3. Consider supportive medications:
   • For anxiety/hyperactivity: Consider trazodone or mirtazapine for sleep issues 1

Special Considerations

• Withdrawal symptoms may be mistaken for physical illness or relapse into depression 3
• Patients on sertraline for 5+ years may require longer tapering periods (several months) 4
• Studies show that tapering strips (allowing carefully titrated dose reduction) can be helpful for patients with troublesome withdrawal symptoms 5
• Approximately 72% of patients using tapering strips were able to successfully discontinue their antidepressants 5

Common Pitfalls to Avoid

• Tapering too quickly (less than 2-4 weeks) offers minimal benefit over abrupt discontinuation 2
• Failing to recognize withdrawal symptoms as distinct from relapse
• Not providing adequate psychological support during tapering
• Stopping at minimum therapeutic doses rather than tapering to much lower doses

Remember that discontinuation symptoms are generally mild and self-limiting but can be distressing enough to impact daily functioning. Proper education and support throughout the tapering process are essential for successful discontinuation.